ArticleFrontiers in pharmacology2026
Cost-effectiveness of pembrolizumab plus weekly paclitaxel for PD-L1-positive platinum-resistant recurrent ovarian cancer in the United States and China.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pembrolizumab plus weekly paclitaxel, with or without bevacizumab, improves survival in programmed death ligand 1 (PD-L1)-positive platinum-resistant recurrent ovarian cancer, but its economic value remains uncertain. This study evaluated the cost-effectiveness of pembrolizumab plus weekly paclitaxel versus placebo plus weekly paclitaxel in patients with PD-L1 combined positive score ≥1 platinum-resistant recurrent ovarian cancer from the Chinese and United States (US) healthcare system perspectives. Methods: A partitioned survival model was developed using data from ENGOT-ov65/KEYNOTE-B96. Outcomes included costs, life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), and incremental net health benefits (INHBs). Cost-effectiveness was assessed against willingness-to-pay (WTP) thresholds of $27,906/QALY in China and $150,000/QALY in the US. Deterministic and probabilistic sensitivity analyses, scenario analyses, and subgroup analyses were performed. Results: In China, pembrolizumab plus weekly paclitaxel increased costs from $31,241.22 to $127,168.48 and increased outcomes from 1.57 to 2.11 LYs and from 1.02 to 1.34 QALYs, yielding 0.54 additional LYs and 0.32 additional QALYs. The ICER was $295,671.88/QALY, with an INMB of -$86,873.48 and an INHB of -3.11 QALYs. In the US, costs increased from $199,488.96 to $451,893.63, and outcomes increased from 1.59 to 2.15 LYs and from 1.03 to 1.37 QALYs. The ICER was $746,255.61/QALY, with an INMB of -$201,670.44 and an INHB of -1.34 QALYs. Pembrolizumab cost and health-state utilities were the main ICER drivers. Probabilistic sensitivity analysis showed 0% cost-effectiveness probability at both WTP thresholds. Scenario and subgroup analyses confirmed the base-case findings. At current bevacizumab prices, pembrolizumab prices would need substantial reductions to meet country-specific WTP thresholds. Conclusion: Compared with placebo plus weekly paclitaxel, pembrolizumab plus weekly paclitaxel improved survival and QALYs in patients with PD-L1-positive platinum-resistant recurrent ovarian cancer but was unlikely to be cost-effective at current prices in either China or the US.
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